The practical implications of the coronary artery surgery trials.

The era of randomised studies of coronary artery bypass surgery''-7 has probably come to an end. It is, therefore, opportune to assess the present state of this form of surgery in the light of the information available from these trials. There is general agreement that coronary artery bypass surgery is effective in relieving angina pectoris, but controversy persists as to whether it can improve prognosis. This topic has recently been extensively reviewed.'8520 Both Braunwaldl8 and Hampton'9 concluded that there is little evidence that coronary artery bypass surgery improves prognosis except in those with severe obstruction of the left main coronary artery, whereas Killip and Ryan20 consider that high risk patients with three vessel disease and reduced ventricular function may also benefit. In this review I reconsider the evidence on the effect of coronary artery bypass surgery on prognosis and discuss the practical implications.